New Delhi: Chronic obstructive pulmonary disease (COPD), long considered a smoker’s disease in old age, is increasingly being diagnosed in people decades younger, new research found. A study published in NEJM Evidence revealed that about one in 22 adults aged 18 to 49 years met the criteria for COPD, based on lung function tests and symptoms such as a persistent cough, excess phlegm or shortness of breath. Many had a smoking history of at least 10 pack-years — the equivalent of smoking a pack a day for a decade.The health consequences for these younger patients were stark: they were over twice as likely to be hospitalised or die from chronic respiratory disease, significantly more likely to develop heart failure and faced an increased risk of early death before the age of 75 years, even after accounting for other factors. Doctors across the city are witnessing this trend firsthand. “At Medanta, we see 30-40 new patients with COPD each month who are under 50 years old,” said Dr Randeep Guleria, chairman, internal medicine, respiratory & sleep medicine. “Although most cases still occur in older adults, younger diagnoses are becoming more common and the outcomes can be worse if treatment is delayed.”Tobacco in all forms remains the leading cause. “Cigarettes, bidis, hookah or chillum — all are equally harmful,” said Dr GC Khilnani, chairman, PSRI Institute of Pulmonary, Critical and Sleep Medicine. “One hookah session can be equivalent to smoking several cigarettes. Passive smoking is also dangerous. A non-smoker regularly exposed to a smoker in the household can still develop COPD.”But smoking is no longer the only culprit. Khilnani warned that indoor and outdoor air pollution now accounted for nearly half of COPD cases in India, up from 10% a few decades ago. Household biomass fuels, vehicle emissions, and industrial pollutants all play a role. Past lung infections such as tuberculosis or childhood pneumonia can also leave lasting damage, as can long-term occupational exposures in industries like coal mining, steel production, or asbestos handling.Early symptoms are often subtle or dismissed as low fitness — a cough lasting more than eight weeks, increased mucus production, breathlessness during routine activities, wheezing, chest tightness, fatigue or frequent respiratory infections. “If these occur in someone with known risk factors, they must get evaluated,” said Dr Pritpal Kaur, pulmonologist, Apollo Spectra Hospital.Research shows that COPD diagnosed before age 50 carries a higher risk of heart complications, repeated hospitalisations and faster lung decline. Younger patients live with the disease for decades, so the cumulative toll is greater — affecting work capacity, quality of life, and life expectancy.Prevention, doctors agree, is the strongest defence. This means quitting smoking, avoiding polluted environments where possible, using protective gear at work and keeping indoor air clean with plants or purifiers. “Even a simple breathing test like spirometry can pick up COPD early,” revealed Dr Bobby Bhalotra, vice-chairperson, chest medicine, Sir Ganga Ram Hospital. “Small steps now can prevent years of breathlessness later.”
